Note: cardiac conditions are inherently unstable.Encyclopedia Entry for Heart Failure :Heart failure - discharge. You were in the hospital to have your heart failure treated. Heart failure occurs when the muscles of your heart are weak or have trouble relaxing, or both. Your heart is a pump that moves fluids through your body. As with any pump, if the flow out of the pump is not enough, fluids do not move well and they get stuck in places they should not be. In your body, this means that fluid collects in your lungs, abdomen, and legs. While you were in the hospital: Your health care team closely adjusted the fluids you drank or received through an intravenous (IV) line. They also watched and measured how much urine you produced. You may have received medicines to help your body get rid of extra fluids. You may have had tests to check how well your heart was working.Your energy will slowly return. You may need help taking care of yourself when you first get home. You may feel sad or depressed. All of these things are normal.Weigh yourself every morning on the same scale when you get up -- before you eat but after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it. Throughout the day, ask yourself: Is my energy level normal? Do I get more short of breath when I am doing my everyday activities? Are my clothes or shoes feeling tight? Are my ankles or legs swelling? Am I coughing more often? Does my cough sound wet? Do I get short of breath at night or when I lie down? If you are having new (or different) symptoms, ask yourself: Did I eat something different than usual or try a new food? Did I take all of my medicines the right way at the right times?.Your health care provider may ask you to limit how much you drink. When your heart failure is not very severe, you may not have to limit your fluids too much. As your heart failure gets worse, you may be asked to limit fluids to 6 to 9 cups (1.5 to 2 liters) a day. You will need to eat less salt. Salt can make you thirsty, and being thirsty can cause you to drink too much fluid. Extra salt also makes fluid stay in your body. Lots of foods that DO NOT taste salty, or that you DO NOT add salt to, still contain a lot of salt. You may need to take a diuretic, or water pill. DO NOT drink alcohol. Alcohol makes it harder for your heart muscles to work. Ask your provider what to do on special occasions where alcohol and foods you are trying to avoid will be served. If you smoke, stop. Ask for help quitting if you need it. DO NOT let anybody smoke in your home. Learn more about what you should eat to make your heart and blood vessels healthier. Avoid fatty foods. Stay away from fast-food restaurants. Avoid some prepared and frozen foods. Learn fast food tips. Try to stay away from things that are stressful for you. If you feel stressed all the time, or if you are very sad, talk with your provider who can refer you to a counselor.Have your entire drug prescriptions filled before you go home. It is very important that you take your drugs the way your health care provider told you to. DO NOT take any other drugs or herbs without asking your provider about them first. Take your drugs with water. DO NOT take them with grapefruit juice, since it may change how your body absorbs certain medicines. Ask your provider or pharmacist if this will be a problem for you. The drugs below are given to many people who have heart failure. Sometimes there is a reason they may not be safe to take, though. These drugs may help protect your heart. Talk with your provider if you are not already on any of these drugs: Antiplatelet drugs (blood thinners) such as aspirin , clopidogrel (Plavix), or warfarin (Coumadin) to help keep your blood from clotting Beta blocker and ACE inhibitor medicines to lower your blood pressure Statins or other drugs to lower your cholesterol Talk to your provider before changing the way you take your medicines. Never just stop taking these drugs for your heart, or any drugs you may be taking for Diabetes, high blood pressure, or other medical conditions you have. If you are taking a blood thinner, such as warfarin (Coumadin), you will need to have extra blood tests to make sure your dose is correct.Your provider may refer you to cardiac rehabilitation program. There, you will learn how to slowly increase your exercise and how to take care of your heart disease. Make sure you avoid heavy lifting. Make sure you know the warning signs of heart failure and of a heart attack. Know what to do when you have chest pain, or angina. Always ask your provider before starting sexual activity again. DO NOT take sildenafil (Viagra), or vardenafil (Levitra), tadalafil (Cialis), or any herbal remedy for erection problems without checking first. Make sure your home is set up to be safe and easy for you for you to move around in and avoid falls. If you are unable to walk around very much, ask your provider for exercises you can do while you are sitting.Make sure you get a flu shot every year. You may also need a pneumonia shot. Ask your provider about this. Your provider may call you to see how you are doing and to make sure you are checking your weight and taking your medicines. You will need follow-up appointments at your provider's office. You will likely need to have certain lab tests to check your sodium and potassium levels and monitor how your kidneys are working.Call your provider if: You gain more than 2 pounds (lb) (1 kilogram, kg) in a day, or 5 lb (2 kg) in a week. You are very tired and weak. You are dizzy and lightheaded. You are more short of breath when you are doing your normal activities. You have new shortness of breath when you are sitting. You need to sit up or use more pillows at night because you are short of breath when you are lying down. You wake up 1 to 2 hours after falling asleep because you are short of breath. You are wheezing and having trouble breathing. You feel pain or pressure in your chest. You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit. Your have swelling in your feet, ankles or legs. You have to urinate a lot, especially at night. You have stomach pain and tenderness. You have symptoms that you think may be from your medicines. Your pulse, or heartbeat, gets very slow or very fast, or it is not steady.Congestive heart failure - discharge; CHF - discharge; HF - discharge.Januzi JL, Mann DL. Clinical assessment of heart failure.Encyclopedia Entry for Heart Failure :Heart failure - fluids and diuretics. When you have heart failure, your heart does not pump out enough blood. This causes fluids to build up in your body. If you drink too many fluids, you may get symptoms such as swelling, weight gain, and shortness of breath. Limiting how much you drink and how much salt (sodium) you take in can help prevent these symptoms. Your family members can help you take care of yourself. They can keep an eye on how much you drink. They can make sure you are taking your medicines the right way. And they can learn to recognize your symptoms early. Your health care provider may ask you to lower the amount of fluids you drink: When your heart failure is not very bad, you may not have to limit your fluids too much. As your heart failure gets worse, you may need to limit fluids to 6 to 9 cups (1.5 to 2 liters) a day.Remember, some foods, such as soups, puddings, gelatin, ice cream, popsicles and others contain fluids. When you eat chunky soups, use a fork if you can, and leave the broth behind. Use a small cup at home for your liquids at meals, and drink just 1 cupful (240 mL). After drinking 1 cup (240 mL) of fluid at a restaurant, turn your cup over to let your server know you DO NOT want more. Find ways to keep from getting too thirsty: When you are thirsty, chew some gum, rinse your mouth with cold water and spit it out, or suck on something such as hard candy, a slice of lemon, or small pieces of ice. Stay cool. Getting overheated will make you thirsty. If you have trouble keeping track of it, write down how much you are drinking during the day. Eating too much salt can make you thirsty, which can make you drink too much. Extra salt also makes more fluid stay in your body. Many foods contain 'hidden salt,' including prepared, canned and frozen foods. Learn how to eat a low-salt diet.Diuretics help your body get rid of extra fluid. They are often called 'water pills.' There are many brands of diuretics. Some are taken 1 time a day. Others are taken 2 times a day. The three common types are: Thiazides: Chlorothiazide (Diuril), chlorthalidone (Hygroton), indapamide (Lozol), hydrochlorothiazide (Esidrix, HydroDiuril), and metolazone (Mykrox, Zaroxolyn) Loop diuretics: Bumentanide (Bumex), furosemide (Lasix), and torasemide (Demadex) Potassium-sparing agents: Amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium) There are also diuretics that contain a combination of two of the drugs above. When you are taking diuretics, you will need to have regular checkups so that your provider can check your potassium levels and monitor how your kidneys are working. Diuretics make you urinate more often. Try not to take them at night before you go to bed. Take them at the same time every day. Common side effects of diuretics are: Fatigue, muscle cramps, or weakness from low potassium levels Dizziness or lightheadedness Numbness or tingling Heart palpitations, or a 'fluttery' heartbeat Gout Depression Irritability Urinary incontinence (not being able to hold your urine) Loss of sex drive (from potassium-sparing diuretics), or inability to have an erection Hair growth, menstrual changes, and a deepening voice in women (from potassium-sparing diuretics) Breast swelling in men or breast tenderness in women (from potassium-sparing diuretics) Allergic reactions -- if you are allergic to sulfa drugs, you should not use thiazides. Be sure to take your diuretic the way you have been told.You will get to know what weight is right for you. Weighing yourself will help you know if there is too much fluid in your body. You might also find that your clothes and shoes are feeling tighter than normal when there is too much fluid in your body. Weigh yourself every morning on the same scale when you get up -- before you eat and after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it. Call your provider if your weight goes up by more than 2 to 3 pounds (1 to 1.5 kilograms, kg) in a day or 5 pounds (2 kg) in a week. Also call your provider if you lose a lot of weight.Call your provider if: You are tired or weak. You feel short of breath when you are active or when you are at rest. You feel short of breath when you lie down, or an hour or two after falling asleep. You are wheezing and having trouble breathing. You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit. You have swelling in your feet, ankles, or legs. You have to urinate a lot, especially at night. You have gained or lost weight. You have pain and tenderness in your belly. You have symptoms that you think might be from your medicines. Your pulse, or heartbeat, gets very slow or very fast, or it is not steady.HF - fluids and diuretics; CHF - ICD discharge; Cardiomyopathy - ICD discharge.Januzi JL, Mann DL. Clinical assessment of heart failure.Encyclopedia Entry for Heart Failure :Heart failure - home monitoring. Knowing your body and the symptoms that tell you your heart failure is getting worse will help you stay healthier and out of the hospital. At home, you should watch for changes in your: Blood pressure Heart rate Pulse Weight When watching out for warning signs, you can catch problems before they get too serious. Sometimes these simple checks will remind you that you forgot to take a pill, or that you have been drinking too much fluid or eating too much salt. Be sure to write down the results of your home self-checks so that you can share them with your health care provider. Your doctor's office may have a 'telemonitor,' a device you can use to send your information automatically. A nurse will go over your self-check results with you in a regular (sometimes weekly) phone call. Throughout the day, ask yourself: Is my energy level normal? Am I getting more short of breath when I am doing my everyday activities? Are my clothes or shoes feeling tight? Are my ankles or legs swelling? Am I coughing more often? Does my cough sound wet? Do I get short of breath at night? These are signs that there is too much fluid building up in your body. You will need to learn how to limit your fluids and salt intake to prevent these things from happening.You will get to know what weight is right for you. Weighing yourself will help you know if there is too much fluid in your body. You might also find that your clothes and shoes are feeling tighter than normal when there is too much fluid in your body. Weigh yourself every morning on the same scale when you get up -- before you eat and after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it. Call your provider if your weight goes up by more than 3 pounds (about 1.5 kilograms) in a day or 5 pounds (2 kilograms) in a week. Also call your provider if you lose a lot of weight.Know what your normal pulse rate is. Your provider will tell you what yours should be. You can take your pulse in the wrist area below the base of your thumb. Use your index and third fingers of your other hand to find your pulse. Use a second hand and count the number of beats for 30 seconds. Then double that number. That is your pulse. Radial pulse Your provider may give you special equipment to check your heart rate.Your provider may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. Show it to your doctor or nurse. It will probably have a cuff with a stethoscope or a digital readout. Practice with your provider to make sure you are taking your blood pressure correctly. Blood pressure Watch this video about: Blood pressure.Call your provider if: You are tired or weak. You feel short of breath when you are active or when you are at rest. You have shortness of breath when you lie down, or an hour or two after falling asleep. You are wheezing and having trouble breathing. You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit. You have swelling in your feet, ankles, or legs. You have to urinate a lot, especially at night. You have gained or lost weight. You have pain and tenderness in your belly. You have symptoms you think might be from your medicines. Your pulse or heartbeat gets very slow or very fast, or it is not regular. Your blood pressure is lower or higher than is normal for you.HF - home monitoring; CHF - home monitoring; Cardiomyopathy - home monitoring.Radial pulse Radial pulse.Januzzi JL, Mann DL. Clinical assessment of heart failure.Encyclopedia Entry for Heart Failure :Heart failure - medicines. You will need to take most of your heart failure medicines every day. Some medicines are taken once a day. Others need to be taken 2 or more times daily. It is very important that you take your medicines at the right time and in the way your doctor has told you. Never stop taking your heart medicines without talking to your health care provider first. This is also true for other medicines you take, such as drugs for diabetes, high blood pressure, and other serious conditions. Your provider may also tell you to take certain medicines or change your doses when your symptoms get worse. DO NOT change your medicines or doses without talking to provider. Always tell your provider before you take any new medicines. This includes over-the-counter medicines such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), as well as drugs such as Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). Also tell your provider before you take any type of herb or supplement.ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) work by opening blood vessels and lowering blood pressure. These medicines can: Reduce the work your heart has to do Help your heart muscle pump better Keep your heart failure from getting worse Common side effects of these drugs include: Dry cough Lightheadedness Fatigue Upset stomach Edema Headache Diarrhea When you take these medicines, you will need to have blood tests to check how well your kidneys are working and to measure your potassium levels. Most of the time, your provider will prescribe either an ACE inhibitor or an ARB. A new drug class called angiotensin receptor-neprilysin inhibitors (ARNI's) combines an ARB drug with a new type of drug. ARNI's may be used to treat heart failure.Beta blockers slow your heart rate and decrease the strength with which your heart muscle contracts in the short term. Long term beta blockers help keep your heart failure from becoming worse. Over time they may also help strengthen your heart. Common beta blockers used for heart failure include carvedilol (Coreg), bisoprolol (Zebeta), and metoprolol (Toprol). DO NOT abruptly stop taking these drugs. This can increase the risk of angina and even a heart attack. Other side effects include lightheadedness, depression, fatigue, and memory loss.Diuretics help your body get rid of extra fluid. Some types of diuretics may also help in other ways. These drugs are often called 'water pills.' There are many brands of diuretics. Some are taken once a day. Others are taken 2 times a day. The most common types are: Thiazides. Chlorothiazide (Diuril), chlorthalidone (Hygroton), indapamide (Lozol), hydrochlorothiazide (Esidrix, HydroDiuril), and metolazone (Mykrox, Zaroxolyn) Loop diuretics. Bumentanide (Bumex), furosemide (Lasix), and torasemide (Demadex) Potassium-sparing agents. Amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium) When you take these medicines, you will need regular blood tests to check how well your kidneys are working and measure your potassium levels.Many people with heart disease take either aspirin or clopidogrel (Plavix). These drugs help prevent blood clots from forming in your arteries. This can lower your risk of a stroke or heart attack. Coumadin (Warfarin) is recommended for patients with heart failure who have a higher risk for blood clots. You will need to have extra blood tests to make sure your dose is correct. You may also need to make changes to your diet. Drugs used less commonly for heart failure include: Digoxin to help increase the heart's pumping strength and slow the heart rate. Hydralazine and nitrates to open up arteries and help the heart muscle pump better. These drugs are mainly used by patients who are unable to tolerate ACE inhibitors and angiotensin receptor blockers. Calcium channel blockers to control blood pressure or angina (chest pain) from coronary artery disease (CAD). Statins and other cholesterol-lowering drugs are used when needed. Antiarrhythmic medicines are sometimes used by heart failure patients who have abnormal heart rhythms. One such drug is amiodarone. A new medicine, Ivabradine (Corlanor), acts to lower the heart rate and may help people with heart failure by reducing the hearts' workload.CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines.Mann DL. Management of heart failure patients with reduced ejection fraction.Encyclopedia Entry for Heart Failure :Heart failure - overview. Heart failure is most often a long-term (chronic) condition, but it may come on suddenly. It can be caused by many different heart problems. The condition may affect only the right side or only the left side of the heart. More often, both sides of the heart are involved. Heart failure is present when: Your heart muscle cannot pump (eject) the blood out of the heart very well. This is called systolic heart failure, or heart failure with a reduced ejection fraction (HFrEF). Your heart muscle is stiff and does not fill up with blood easily. This is called diastolic heart failure, or heart failure with a preserved ejection fraction (HFpEF). As the heart's pumping becomes less effective, blood may back up in other areas of the body. Fluid may build up in the lungs, liver, gastrointestinal tract, and the arms and legs. This is called congestive heart failure. Circulation of blood through the heart The most common causes of heart failure are: Coronary artery disease (CAD), a narrowing or blockage of the small blood vessels that supply blood and oxygen to the heart. This can weaken the heart muscle over time or suddenly. High blood pressure that is not well controlled, leading to problems with stiffness, or eventually leading to muscle weakening. Other heart problems that may cause heart failure are: Congenital heart disease Heart attack (when coronary artery disease results in a sudden blockage of a heart artery) Heart valves that are leaky or narrowed Infection that weakens the heart muscle Some types of abnormal heart rhythms (arrhythmias) Other diseases that can cause or contribute to heart failure: Amyloidosis Emphysema Overactive thyroid Sarcoidosis Severe anemia Too much iron in the body Underactive thyroid.Symptoms of heart failure often begin slowly. At first, they may only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when you are resting. Symptoms may also appear suddenly after the heart is damaged from a heart attack or other problem. Common symptoms are: Cough Fatigue, weakness, faintness Loss of appetite Need to urinate at night Pulse that feels fast or irregular, or a sensation of feeling the heartbeat (palpitations) Shortness of breath when you are active or after you lie down Swollen (enlarged) liver or abdomen Swollen feet and ankles Waking up from sleep after a couple of hours due to shortness of breath Weight gain.Your health care provider will examine you for signs of heart failure: Fast or difficult breathing Leg swelling (edema) Neck veins that stick out (are distended) Sounds (crackles) from fluid buildup in your lungs, heard through a stethoscope Swelling of the liver or abdomen Uneven or fast heartbeat and abnormal heart sounds Foot swelling Many tests are used to diagnose and monitor heart failure. An echocardiogram (echo) is most often the best first test for people when heart failure is being evaluated. Your provider will use it to guide your treatment. Other imaging tests can look at how well your heart is able to pump blood, and how much the heart muscle is damaged. Many blood tests may also be used to: Help diagnose and monitor heart failure Identify risks for various types of heart disease Look for possible causes of heart failure, or problems that may make your heart failure worse Monitor for side effects of medicines you may be taking.MONITORING AND SELF CARE If you have heart failure, your provider will monitor you closely. You will have follow-up visits at least every 3 to 6 months, but sometimes much more often. You will also have tests to check your heart function. Knowing your body and the symptoms that your heart failure is getting worse will help you stay healthier and out of the hospital. At home, watch for changes in your heart rate, pulse, blood pressure, and weight. Weight gain, especially over a day or two, can be a sign that your body is holding on to extra fluid and your heart failure is getting worse. Talk to your provider about what you should do if your weight goes up or you develop more symptoms. Limit how much salt you eat. Your provider may also ask you to limit how much fluid you drink during the day. Other important changes to make in your lifestyle: Ask your provider how much alcohol you may drink. DO NOT smoke. Stay active. Walk or ride a stationary bicycle. Your provider can provide a safe and effective exercise plan for you. DO NOT exercise on days when your weight has gone up from fluid or you are not feeling well. Lose weight if you are overweight. Lower your cholesterol by changing your lifestyle. Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest too. MEDICINES, SURGERY, AND DEVICES You will need to take medicines to treat your heart failure. Medicines treat the symptoms, prevent your heart failure from getting worse, and help you live longer. It is very important that you take your medicine as your health care team directed. These medicines: Help the heart muscle pump better Keep your blood from clotting Lower your cholesterol levels Open up blood vessels or slow your heart rate so your heart does not have to work as hard Reduce damage to the heart Reduce the risk of abnormal heart rhythms Replace potassium Rid your body of excess fluid and salt (sodium) It is very important that you take your medicine as directed. DO NOT take any other drugs or herbs without first asking your provider about them. Drugs that may make your heart failure worse include: Ibuprofen (Advil, Motrin) Naproxen (Aleve, Naprosyn) The following surgeries and devices may be recommended for some people with heart failure: Coronary bypass surgery (CABG) or angioplasty with or without stenting may help improve blood flow to the damaged or weakened heart muscle. Heart valve surgery may be done if changes in a heart valve are causing your heart failure. A pacemaker can help treat slow heart rates or help both sides of your heart contract at the same time. A defibrillator sends an electrical pulse to stop life-threatening abnormal heart rhythms. END-STAGE HEART FAILURE Severe heart failure occurs when treatments no longer work. Certain treatments may be used when a person is waiting for (or instead of) a heart transplant: Intra-aortic balloon pump (IABP) Left or right ventricular assist device (LVAD) Total artificial heart At a certain point, the provider will decide whether it is best to keep treating heart failure aggressively. The person, along with his or her family and doctors, may want to discuss palliative or comfort care at this time.Often, you can control heart failure by taking medicine, changing your lifestyle, and treating the condition that caused it. Heart failure can suddenly get worse due to: Ischemia (lack of blood flow to the heart muscle) Eating high-salt foods Heart attack Infections or other illnesses Not taking medicines correctly New, abnormal heart rhythms Most of the time, heart failure is a chronic illness that gets worse over time. Some people develop severe heart failure. Medicines, other treatments, and surgery no longer help at this stage. People with heart failure may be at risk for dangerous heart rhythms. These people often receive an implanted defibrillator.Call your provider if you develop: Increased cough or phlegm Sudden weight gain or swelling Weakness Other new or unexplained symptoms Go to the emergency room or call the local emergency number (such as 911) if: You faint You have fast and irregular heartbeat (especially if you also have other symptoms) You feel a severe crushing chest pain.Most cases of heart failure can be prevented by living a healthy lifestyle and taking steps aimed at reducing your risk for heart disease..CHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failure - cor pulmonale; Cardiomyopathy - heart failure; HF.ACE inhibitors Antiplatelet drugs - P2Y12 inhibitors Being active when you have heart disease Heart bypass surgery - discharge Heart failure - discharge Heart failure - fluids and diuretics Heart failure - home monitoring Heart failure - what to ask your doctor Heart pacemaker - discharge Implantable cardioverter defibrillator - discharge.Heart, section through the middle Heart, section through the middle Heart, front view Heart, front view Circulation of blood through the heart Circulation of blood through the heart Foot swelling Foot swelling.Allen LA and Stevenson LW. Management of patients with cardiovascular disease approaching the end of life.Encyclopedia Entry for Heart Failure :Heart failure - palliative care. Chronic heart failure very often gets worse over time. Many people who have heart failure die of the condition. It can be hard to think and talk about the type of care you want at the end of your life. However, discussing these subjects with your doctors and loved ones may help bring you peace of mind. You may have already discussed heart transplantation and the use of a ventricular assist device with your doctor. At some point, you will be faced with the decision about whether to continue active or aggressive treatment of heart failure. Then, you may want to discuss the option of palliative or comfort care with your providers and loved ones. Many people wish to stay in their homes during the end of life period. This is often possible with the support of loved ones, caregivers, and a hospice program. You may need to make changes in your home to make life easier and keep you safe. Hospice units in hospitals and other nursing facilities are also an option. Advance care directives are documents that state the type of care you would like to have if you are unable to speak for yourself.Fatigue and breathlessness are common problems at the end of life. These symptoms can be distressing. You may feel short of breath and have trouble breathing. Other symptoms may include tightness in the chest, feeling as if you are not getting enough air, or even feeling like you're being smothered. Family or caregivers can help by: Encouraging the person to sit upright Increasing the airflow in a room by using a fan or opening a window Helping the person relax and not panic Using oxygen will help you combat shortness of breath and keep a person with end-stage heart failure comfortable. Safety measures (such as not smoking) are very important when using oxygen at home. Morphine can also help shortness of breath. It is available as a pill, liquid, or tablet that dissolves under the tongue. Your provider will tell you how to take morphine.Symptoms of fatigue, shortness of breath, loss of appetite, and nausea can make it hard for people with heart failure to take in enough calories and nutrients. Wasting of muscles and weight loss are part of the natural disease process. It can help to eat several small meals. Choosing foods that are appealing and easy to digest can make it easier to eat. Caregivers should not try to force a person with heart failure to eat. This does not help the person live longer and may be uncomfortable. Talk to your provider about things you can do to help manage nausea or vomiting and constipation.Anxiety, fear, and sadness are common among people with end-stage heart failure. Family and caregivers should look for signs of these problems. Asking the person about his or her feelings and fears can make it easier to discuss them. Morphine can also help with fearfulness and anxiety. Certain antidepressants may also be useful. Pain is a common problem in the end stages of many diseases, including heart failure. Morphine and other pain medicines can help. Common over-the-counter pain medicines, such as ibuprofen, are often not safe for people with heart failure. Some people may have problems with bladder control or bowel function. Talk with your provider before using any medicines, laxatives, or suppositories for these symptoms.CHF - palliative; Congestive heart failure - palliative; Cardiomyopathy - palliative; HF - palliative; Cardiac cachexia; End-of-life-heart failure.Goodlin SJ, Bonow RO. Care of patients with end-stage heart disease.Encyclopedia Entry for Heart Failure :Heart failure - surgeries and devices. A heart pacemaker is a small, battery-operated device that sends a signal to your heart. The signal makes your heart beat at the correct pace. Pacemaker Pacemakers may be used: To correct abnormal heart rhythms. The heart may beat too slowly, too fast, or in an irregular manner. To better coordinate the beating of the heart in people with heart failure. These are called biventricular pacemakers. When your heart is weakened, gets too large, and does not pump blood very well, you are at high risk for abnormal heartbeats that can lead to sudden cardiac death. An implantable cardioverter-defibrillator (ICD) is a device that detects heart rhythms. It quickly sends an electrical shock to the heart to change the rhythm back to normal. Most biventricular pacemakers can also work as implantable cardio-defibrillators (ICD).The most common cause of heart failure is coronary artery disease (CAD), which is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CAD may become worse and make it harder to manage your symptoms. Coronary artery disease Watch this video about: Coronary artery disease After performing certain tests your health care provider may feel that opening a narrowed or blocked blood vessel will improve your heart failure symptoms. Suggested procedures may include: Angioplasty and stent placement Heart bypass surgery.Blood that flows between the chambers of your heart, or out of your heart into the aorta, must pass through a heart valve. These valves open enough to allow blood to flow through. They then close, keeping blood from flowing backward. When these valves do not work well (become too leaky or too narrow), blood does not flow correctly through the heart to the body. This problem may cause heart failure or make heart failure worse. Heart valve surgery may be needed to repair or replace one of the valves.Some types of surgery are done for severe heart failure when other treatments no longer work. These procedures are often used when a person is waiting for a heart transplant. They are also sometimes used long term in cases when transplant is not planned or possible. Examples of some of these devices include left ventricular assist device (LVAD) , right ventricular assist devices (RVAD) or a total artificial hearts. They are considered for use if you have severe heart failure that cannot be controlled with medicine or a special pacemaker. Ventricular assist devices (VAD) help your heart pump blood from the pumping chambers of your heart to either the lungs or to the rest of your body These pumps may be implanted in your body or connected to a pump outside your body. You may be on a waiting list for a heart transplant. Some patients who get a VAD are very ill and may already be on a heart-lung bypass machine. Total artificial hearts are being developed, but are not yet in wide use. Devices inserted thru a catheter such as intra-aortic balloon pumps (IABP) are sometimes used. An IABP is a thin balloon that is inserted into an artery (most often in the leg) and threaded into the main artery exiting the heart (aorta). These devices can help maintain heart function in the short term. Because they can be placed quickly, they are useful for patients who have a sudden and severe decline in heart function They are used in people who are waiting for recovery or for more advanced assist devices.CHF - surgery; Congestive heart failure - surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure.Pacemaker Pacemaker.Aaronson KD, Pagani FD. Mechanical circulatory support.Encyclopedia Entry for Heart Failure :Heart failure - tests. An echocardiogram (echo) is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image. This test helps your health care provider learn more about how well your heart contracts and relaxes. It also provides information about the size of your heart and how well the heart valves are working. An echocardiogram is the best test to: Identify which type of heart failure (systolic, diastolic, valvular) Monitor your heart failure and guide your treatment Heart failure can be diagnosed if the echocardiogram shows that the pumping function of the heart is too low. This is called an ejection fraction. A normal ejection fraction is around 55% to 65%. If only some parts of the heart are not working correctly, it may mean that there is a blockage in the artery of the heart that delivers blood to that area.Many other imaging tests are used to look at how well your heart is able to pump blood and the extent of heart muscle damage. You may have a chest x-ray done in your provider's office if your symptoms suddenly become worse. However, a chest x-ray cannot diagnose heart failure. Ventriculography is another test that measures the overall squeezing strength of the heart (ejection fraction). Like an echocardiogram, it can show parts of the heart muscle that are not moving well. This test uses x-ray contrast fluid to fill the pumping chamber of the heart and evaluate its function. It is often done at the same time as other tests, such as coronary angiography. MRI , CT , or PET scans of the heart may be done to check how much heart muscle damage is present. It can also help detect the reason for a patient's heart failure. Stress tests are done to see whether the heart muscle is getting enough blood flow and oxygen when it is working hard (under stress). Types of stress tests include: Nuclear stress test Exercise stress test Stress echocardiogram Your provider may order a heart catheterization if any imaging tests show that you have narrowing in one of your arteries, or if you are having chest pain (angina).Several different blood tests can be used to learn more about your condition. Tests are done to: Help diagnose the cause for and monitor heart failure. Identify risk factors for heart disease. Look for possible causes of heart failure or problems that may make your heart failure worse. Monitor side effects of medications you may be taking. Blood urea nitrogen (BUN) and serum creatinine tests help monitor how well your kidneys are working. You will need these tests regularly if: You are taking medicines called ACE inhibitors or ARBs (angiotensin receptor blockers) Your provider makes changes to the doses of your medicines You have more severe heart failure Sodium and potassium levels in your blood will need to be measured on a regular basis when there are changes made for some medicines including: ACE inhibitors, ARBs, or certain types of water pills (amiloride, spironolactone, and triamterene) that can make your potassium levels too high Most other types of water pills, which can make your sodium too low or your potassium too high Anemia, or low red blood cell count, can make your heart failure worse. Your provider will check your CBC or complete blood count on a regular basis or when your symptoms become worse.CHF - tests; Congestive heart failure - tests; Cardiomyopathy - tests; HF - tests.Mann DL. Management of heart failure patients with reduced ejection fraction.Encyclopedia Entry for Heart Failure :Heart failure - what to ask your doctor. What kinds of heath checks do I need to do at home and how do I do them? How do I check my pulse and blood pressure? How should I check my weight? When should I do these checks? What supplies do I need? How should I keep track of my blood pressure, weight, and pulse? What are the signs and symptoms that my heart failure is getting worse? Will I always have the same symptoms? What should I do if my weight goes up? If my legs swell up? If I feel more short of breath? If my clothes feel tight? What are the signs and symptoms that I am having angina or a heart attack? When should I call the doctor? When should I call 911? What medicines am I taking to treat heart failure? Do they have any side effects? What should I do if I miss a dose? Is it ever safe to stop taking any of these medicines on my own? What over-the-counter medicines are NOT compatible with my regular medicines? How much activity or exercise can I do? Which activities are better to start with? Are there activities or exercises that are not safe for me? Is it safe for me to exercise on my own? Do I need to go to a cardiac rehabilitation program? Are there limits on what I can do at work? What should I do if I feel sad or very worried about my heart disease? How can I change the way I live to make my heart stronger? How much water or fluid can I drink every day? How much salt can I eat? What are other types of seasoning I can use instead of salt? What is a heart-healthy diet? Is it ever ok to eat something that is not heart-healthy? What are some ways to eat healthy when I go to a restaurant? Is it ok to drink alcohol? How much is ok? Is it ok to be around other people who are smoking? Is my blood pressure normal? What is my cholesterol, and do l need to take medicines for it? Is it ok to be sexually active? Is it safe to use sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) for erection problems?.What to ask your doctor about heart failure; HF - what to ask your doctor.McmurrayJJV, Pfeffer MA. Heart failure: Management and prognosis.Encyclopedia Entry for Heart Failure :Heart failure in children - home care. Home monitoring helps you and your child stay on top of your child's heart failure. Doing so can help catch problems before they get too serious. Sometimes these simple checks will remind you that your child has been drinking too much fluid or eating too much salt. Be sure to write down the results of your child's home checks so that you can share them with your child's health care provider. You may need to keep a chart, or the doctor's office may have a 'telemonitor,' a device you can use to send your child's information automatically. A nurse will go over your child's home results with you in a regular phone call. Throughout the day, watch for these signs or symptoms in your child: Low energy level Shortness of breath when doing everyday activities Clothes or shoes that feel tight Swelling in the ankles or legs Coughing more often or a wet cough Shortness of breath at night Weighing your child will help you know if there is too much fluid in their body. You should: Weigh your child every morning on the same scale upon awakening. Before they eat and after they use the bathroom. Make sure your child wears similar clothing each time. Ask your child's provider what range their weight should stay within. Also call the provider if your child loses a lot of weight.Babies and infants' bodies are working extra hard because of heart failure. Infants may be too tired to drink enough breast milk or formula when feeding. So they often need extra calories to help them grow. Your child's provider may suggest a formula that has more calories packed into every ounce. You may need to keep track of how much formula is taken, and report when your child has diarrhea. Babies and infants will also need extra nutrition through a feeding tube. Older children also may not eat enough due to a decrease in appetite. Even older children may require a feeding tube, either all of the time, just part of the day, or when weight loss occurs. When more severe heart failure is present, your child may need to limit the amount of salt and total fluids taken in every day.Your child will need to take medicines to treat heart failure. Medicines treat the symptoms and prevent heart failure from getting worse. It is very important that your child take the medicine as directed by the health care team. These medicines: Help the heart muscle pump better Keep blood from clotting Open up blood vessels or slow the heart rate so the heart does not have to work as hard Reduce damage to the heart Reduce the risk of abnormal heart rhythms Replace potassium Rid the body of excess fluid and salt (sodium) Your child should take heart failure medicines as directed. DO NOT allow your child to take any other drugs or herbs without first asking your child's provider about them. Common drugs that may make heart failure worse include: Ibuprofen (Advil, Motrin) Naproxen (Aleve, Naprosyn) If your child requires oxygen at home , you will need to know how to store and use oxygen. If you are traveling, plan ahead. You will also need to learn about oxygen safety in the home. Some children may need to limit or restrict certain activities or sports. Be sure to discuss this with the provider.Call your child's provider if your child: Is tired or weak. Feels short of breath when active or at rest. Has a bluish skin color around the mouth or on the lips and tongue. Is wheezing and having trouble breathing. This is seen more in infants. Has a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit. Has swelling in the feet, ankles, or legs. Has gained or lost weight. Has pain and tenderness in the belly. Has a very slow or very fast pulse or heartbeat, or it is not regular. Has blood pressure that is lower or higher than is normal for your child.Congestive heart failure (CHF) - home monitoring for children; Cor pulmonale - home monitoring for children; Cardiomyopathy - heart failure home monitoring for children.American Heart Association. Heart failure in children and adolescents. Updated April 6, 2015. www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Heart-Failure-in-Children-and-Adolescents_UCM_311919_Article.jsp#.V9GZWpgrKUk. Accessed July 1, 2016. Bernstein D. Heart failure.Encyclopedia Entry for Heart Failure :Heart failure in children - overview. The heart is composed of two independent pumping systems. One is on the right side, and the other is on the left. Each has two chambers, an atrium and a ventricle. The ventricles are the major pumps in the heart. The right system receives blood from the veins of the whole body. This is 'used' blood, which is poor in oxygen and rich in carbon dioxide. The left system receives blood from the lungs. This blood is now rich in oxygen. Blood leaves the heart through the aorta, the major artery that feeds blood to the entire body. Valves are muscular flaps that open and close so blood will flow in the right direction. There are four valves in the heart. One common way heart failure occurs in children is when the blood from the left side of the heart mixes with the right side of the heart. This leads to an overflow of blood into the lungs or one or more chambers of the heart. This occurs most often due to birth defects of the heart or major blood vessels. These include: A hole between the right or left upper or lower chambers of the heart A defect of the major arteries Defective heart valves that are leaky or narrowed A defect in the formation of the heart chambers Abnormal development or damage to the heart muscle is the other common cause of heart failure. This may be due to: Infection from a virus or bacteria that causes damage to the heart muscle or heart valves Drugs used for other illnesses, most often cancer drugs Abnormal heart rhythms Muscle disorders, such as muscular dystrophy Genetic disorders leading to abnormal development of the heart muscle.As the heart's pumping becomes less effective, blood may back up in other areas of the body. Fluid may build up in the lungs, liver, abdomen, and the arms and legs. This is called congestive heart failure. Symptoms of heart failure may be present at birth, start during the first weeks of life, or develop slowly in an older child. Symptoms of heart failure in infants may include: Breathing problems, such as rapid breathing or breathing that appears to take more effort. These may be noticed when the child is resting or when feeding or crying. Taking longer than normal to feed, or becoming too tired to continue feeding after a short time. Noticing a fast or strong heart beat thru the chest wall when the child is at rest. Not gaining enough weight. Common symptoms in older children are: Cough Fatigue, weakness, faintness Loss of appetite Need to urinate at night Pulse that feels fast or irregular, or a sensation of feeling the heart beat (palpitations) Shortness of breath when the child is active or after lying down Swollen (enlarged) liver or abdomen Swollen feet and ankles Waking up from sleep after a couple of hours due to shortness of breath Weight gain.The health care provider will examine your child for signs of heart failure: Fast or difficult breathing Leg swelling (edema) Neck veins that stick out (are distended) Sounds (crackles) from fluid buildup in your child s lungs, heard through a stethoscope Swelling of the liver or abdomen Uneven or fast heartbeat and abnormal heart sounds Many tests are used to diagnose and monitor heart failure. A chest x-ray and an echocardiogram are most often the best first tests when heart failure is being evaluated. Your provider will use them to guide your child's treatment. Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. It may be done to measure pressure, blood flow, and oxygen levels in different parts of the heart. Other imaging tests can look at how well your child's heart is able to pump blood, and how much the heart muscle is damaged. Many blood tests may also be used to: Help diagnose and monitor heart failure Look for possible causes of heart failure or problems that may make heart failure worse Monitor for side effects of medicines your child may be taking.Treatment often involves a combination of monitoring, self-care, and medicines and other medical treatments. MONITORING AND SELF-CARE Your child will have follow-up visits at least every 3 to 6 months, but sometimes much more often. Your child will also have tests to check heart function. All parents and caregivers must learn how to monitor the child at home.You also need to learn the symptoms that heart failure is getting worse. Recognizing the symptoms early will help your child stay out of the hospital. At home, watch for changes in heart rate, pulse, blood pressure, and weight. Talk to your child's doctor about what you should do when weight goes up or your child develops more symptoms. Limit how much salt your child eats. Your doctor may also ask you to limit how much fluid your child drinks during the day. Your child needs to get enough calories to grow and develop. Some children require feeding tubes. Your child's provider can provide a safe and effective exercise and activity plan. MEDICINES, SURGERY, AND DEVICES Your child will need to take medicines to treat heart failure. Medicines treat the symptoms and prevent heart failure from getting worse. It is very important that your child take any medicines as directed by the health care team. These medicines: Help the heart muscle pump better Keep blood from clotting Open up blood vessels or slow the heart rate so the heart does not have to work as hard Reduce damage to the heart Reduce the risk of abnormal heart rhythms Rid the body of excess fluid and salt (sodium) Replace potassium Prevent blood clots from forming Your child should take medicines as directed. DO NOT take any other drugs or herbs without first asking the provider about them. Common drugs that may make heart failure worse include: Ibuprofen (Advil, Motrin) Naproxen (Aleve, Naprosyn) The following surgeries and devices may be recommended for some children with heart failure: Surgery to correct different heart defects Heart valve surgery A pacemaker can help treat slow heart rates or help both sides of your child's heart contract at the same time. A pacemaker is a small, battery-operated device that is inserted under the skin on the chest. Children with heart failure may be at risk for dangerous heart rhythms. They often receive an implanted defibrillator. Heart transplantation may be needed for severe, end-stage heart failure.Long-term outcomes depend on a number of factors. These include: What types of heart defects are present and whether they can be repaired Severity of any permanent damage to the heart muscle Other health or genetic problems that may be present Often, heart failure can be controlled by taking medicine, making changes in lifestyle, and treating the condition that caused it.Call your provider if your child develops: Increased cough or phlegm Sudden weight gain or swelling Poor feeding or poor weight gain over time Weakness Other new or unexplained symptoms Go to the emergency room or call the local emergency number (such as 911) if your child: Faints Has a fast and irregular heartbeat (especially with other symptoms) Feels a severe crushing chest pain.Congestive heart failure - children; Cor pulmonale - children; Cardiomyopathy - children; CHF - children; Congenital heart defect - heart failure in children; Cyanotic heart disease - heart failure in children; Birth defect of the heart - heart failure in children.Bernstein D. Heart failure.